Clinical effectiveness of robotic-assisted compared to open or video-assisted lobectomy in Germany: a real-world data analysis

Abstract OBJECTIVES Despite robotic-assisted (RATS) lobectomy is on the rise in Europe, the majority of lobectomies in Germany are still performed with an open or thoracoscopic (VATS) approach. Empirical evidence in favour of RATS lobectomy is inconsistent. This retrospective cohort study investigates the impact of RATS lobectomy compared with OPEN (open thoracic surgery) and VATS lobectomy on short-term outcomes in Germany using multicentre real-world data. METHODS Anonymized routine data from Germany from 2018 to 2020 were retrospectively analyzed. These data were provided by 61 German hospitals. Propensity Score Matching (PSM) with subsequent Generalized Linear Models (GLM) was performed for statistical analysis. Additionally, in order to test the robustness of the results, multivariable regression analyses with cluster robust standard errors were used. RESULTS 2,498 patients with lobectomy were identified: In 1,345 patients OPEN, in 983 VATS and 170 a RATS lobectomy was performed. RATS—compared to OPEN and VATS—reduced length of stay by 28% or 4.2 days [CI: 2.9; 5.4] and by 13% or 1.6 days [CI: 0.2; 3.0], respectively. The risk of pneumonia was reduced by 5.3 percentage points in the RATS group compared to both OPEN and VATS (p = 0.07/0.01). RATS—compared to an open approach—reduces the risk of blood transfusions by 8.8 percentage points (p < 0.001) and length of stay on the ICU (p < 0.001). CONCLUSION This study provides strong support that RATS lobectomy outperforms OPEN or VATS lobectomy in terms of hospital length of stay, and short-term in-hospital postoperative complications in the real-world scenario in Germany.